A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder
Section snippets
Multidimensional meta-analysis
A multidimensional meta-analysis presents a range of statistics bearing on clinical utility and external validity, which can be important in assessing the strengths and limitations of treatments of psychiatric disorders, whether psychotherapeutic or pharmacologic (or both). One important variable pertains to the process by which patients are selected and screened. Studies that screen out a high proportion of subjects or that implement stringent exclusion criteria before patients are even
Selection of studies
We used a two-phase search process to identify randomized controlled trials (RCTs) of psychotherapy for OCD published between January 1980 and December 2001: (1) a search of PsycINFO and Medline, using the keywords “obsessive-compulsive” and “OCD”; and (2) a manual review of prior meta-analyses and reviews for studies not obtained using the first procedure. To be included, a study had to test the efficacy of a specific psychotherapy against a control condition, an alternative psychotherapy, a
Selection of studies
To maximize the likelihood of obtaining all relevant published research reports, we used a three-phase search process. First, we performed an issue-by-issue search of 22 high quality, high-impact journals that routinely publish efficacy research, including research on OCD (e.g., American Journal of Psychiatry, Archives of General Psychiatry). Next, we conducted an exhaustive computer search of PsycINFO and Medline using the keywords “obsessive compulsive.” Last, we manually reviewed prior
Discussion
The data reported here replicate findings reported in other meta-analyses and reviews regarding the efficacy of psychotherapy for OCD and extend them in a number of ways. Consistent with prior meta-analyses, both psychotherapy and pharmacotherapy produce substantial decreases in OCD symptoms, reflected in (a) pre-treatment vs. post-treatment effect sizes; (b) a substantial percentage of patients who improve with treatment and (c) considerable declines in symptoms from pre- to post-treatment.
Acknowledgement
Preparation of this manuscript was supported in part by NIMH grants MH62377 and MH62378 to the fourth author.
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